Immune globulin
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Lack of efficacy: case report A 56-year-old man exhibited lack of efficacy during treatment with immune globulin for autoimmune haemolytic anaemia (AIHA). The man, who had a history of hypertension, presented to emergency department with loss of smell, fatigue and headache. He reported contact with a patient known to have coronavirus disease-19 (COVID-19). Investigations led to a diagnosis of COVID-19. Therefore, he started receiving off-label therapy with azithromycin 500mg on day 1 followed by 250mg on days 2–5. He was then discharged. After 4 days, he was hospitalised with progressive fatigue, dyspnoea and cough. Chest CT result was consistent with COVID-19 pneumonia. On the basis of his progressive COVID-19 infection, he started receiving off-label therapy with favipiravir 1600mg two times a day on day 1 followed by 600mg two times a day for a total duration of 5 days. Additionally, he was diagnosed with secondary AIHA, which was triggered by COVID-19. Therefore, he started receiving IV immune globulin [immunoglobulin] 1 g/kg/day for 2 consecutive days. However, on day 3 of immune globulin treatment, he remained transfusion dependent (haemoglobin 5 g/dL), indicating no response to immune globulin (lack of efficacy). Therefore, the man was treated with prednisolone. On day 12 of hospitalisation (i.e. day 8 of prednisolone treatment), he was completely transfusion independent. He was symptom-free with resolution of his underlying pneumonia. On hospital day 14 (i.e. the day of discharge), his complete blood count results were as follows: haemoglobin 8.5 g/dL, neutrophil count 9800 /mm3, lymphocyte 1450 /mm3, total leukocyte count 12130 /mm3 and platelet count 437000 /mm3. Also, his nasopharyngeal swab sample was negative for COVID-19. One week following discharge, his haemoglobin was 10.7 g/dL. Hindilerden F, et al. Severe autoimmune hemolytic Anemia in COVID-19 Infection, safely treated with steroids. Mediterranean Journal of Hematology and Infectious Diseases 12: No. 1, 2020. Available from: URL: http://doi.org/10.4084/MJHID.2020.053 803514687
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Reactions 14 Nov 2020 No. 1830
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